HomeMy WebLinkAboutF2019-0425 - Permit ApplicationT-_2n1I - D142';-
Worksheet for Fire Permit Application a ���qm
print Form City of Newport Beach - Building Department o
Please print 3 copies Ct,FUM1r��
Associated Building permit #X2019-1420 r' Fire Sprinkler Fx— Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
360
1 Oo Bayview Cr. Newport Beach CA 92660 3rd
# Units r—,
Tenant Name
2. Description of Work
Use F�
Removal of all existing visual and audio-visual notification appliances. And installation of new
visual and audio/visual notification devices. (9) Devices
Valuation $ 2,611.00
1
Ex3,6
tg Sq Ft F� New/Added Sq Ft �— Total Sq Ft 84 Sq Ft j
#Stories
r New r Add r Alter r, Demo
III
Check Appropriate Box for ApplicanVNotification Information
3. Owner's Name Last �— First
Owner's Address Owner's E-mail Address
City �— State F Zip F Telephone—
r 4. Architect/Designer's Name LastCarrillo First Hector Lic. No.
F
Architect/Designer's Address Architect/Designer's E-mail Address
1354 S. Parkside PI.
City Ontario State CA ZIP 91761 Telephone 909-957-5200
g �', Lic. No.
5. Engineer's Name Last First
Engineer's Address Engineer's E-mail Address
City State F Zip r� Telephone
rj 6. Contractor's Name Last HCI Systems Inc First �! Lic. No. 905493 Class c7c10c16'
Contractor's Address Contractor's E-mail Address
1354 S. Parkside PI. Eng5@hcisystems.net
City Ontario State CA ZIP 91761 Telephone 909-957-5200„
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP Zo I _ O -S Z_,C_j PLAN CHECK FEE $